Provider Demographics
NPI:1285721688
Name:MACDONALD, RALPH EVAN JR (DDS)
Entity type:Individual
Prefix:
First Name:RALPH
Middle Name:EVAN
Last Name:MACDONALD
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 SOUTH COUNTRYSIDE DRIVE
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44805
Mailing Address - Country:US
Mailing Address - Phone:419-289-2896
Mailing Address - Fax:
Practice Address - Street 1:910 KATHERINE AVENUE
Practice Address - Street 2:SUITE A
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805
Practice Address - Country:US
Practice Address - Phone:419-289-1813
Practice Address - Fax:419-281-8279
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH209491223G0001X
NC65101223G0001X
MI29010142601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice